'Pause the Draws' toolkit
Why Pause the Draws?
Repetitive lab testing on inpatients is common and can have a variety of negative consequences. In addition to the overuse of test reagents, clerical, nursing and laboratory resources, the downstream impact of unnecessary or inappropriate lab testing includes delayed or incorrect diagnosis, over-treatment, additional phlebotomy, iatrogenic anemia, and patient inconvenience. As in all instances of over testing there is a clear risk for false positive results which can then lead to further work-ups of incidental and non-pathological results.
Clinicians should be encouraged to engage in ‘reflective’ ordering patterns based upon clinical indications rather than ingrained habits. Diagnostic tests should only be ordered to help answer clinical questions, or when test results will affect patient care management. Mentoring and active engagement of residents, Advanced Practice Providers and bedside nurses is important to reduce unnecessary testing. Messaging should reflect that the goal is to increase targeted, appropriate testing rather than to decrease overall lab testing.
Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. For hospitalized patients, targeting high volume repetitive daily tests is a logical, evidence based and patient-centered intervention that can have a significant impact.
Downloadable Talking Points
Choosing Wisely Lists Supporting 'Pause the Draws'
Don’t perform repetitive CBC and chemistry testing in the face of clinical and lab stability.
Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions.
The Collaborative includes the American Association of Critical-Care Nurses, American Thoracic Society, the American College of Chest Physicians and the Society of Critical Care Medicine.
Don’t perform laboratory blood testing unless clinically indicated or necessary for diagnosis or management in order to avoid iatrogenic anemia.
Don’t perform serial blood counts on clinically stable patients.